交叉换血治疗新生儿重度高胆红素血症的调查  

Exchange transfusion in the treatment of neonatal sever hyperbilirubinemia

作　　者：无 马莉[2] 

机构地区：[1]中国医师协会输血科医师分会儿童输血专业委员会 [2]河北省儿童医院

出　　处：《中国输血杂志》2020年第10期1003-1006,共4页Chinese Journal of Blood Transfusion

摘　　要：目的调查我国目前新生儿换血术在新生儿重症监护病房的应用现状。方法采用在网上设计调查问卷的方法,于2019年4—6月通过微信方式将问卷链接发送,受调人为来自全国31个省市的中国医师协会输血科医师分会儿童输血专业委员会委员38名,由所在医院输血科或新生儿科(儿科)医生完成问卷,并由各位委员将问卷链接发送至各省市自治区有新生儿换血病例的医院,调查内容围绕换血操作相关事项,共计27个问题。结果收到259份有效回复,77%(199/259)受调医院2018年全年换血例数<20例;绝大多数医院在直接或间接应用美国儿科学会2004年颁布的新生儿换血标准;38%(98/259)在换血前常规应用白蛋白,44%(114/259)在换血过程中常规静脉推注钙剂,72%(186/259)在换血过程中会暂停蓝光照射;关于血源,红细胞与血浆比例58%(150/259)选择(2—3)∶1,21%(54/259)的受调者不清楚保存多长时间的红细胞不再适合换血操作;主要的换血相关并发症包括感染、因出入不平衡导致循环障碍、生化和代谢紊乱。结论本调查显示,我国目前新生儿换血术的实施过程中,对换血血源的处理、换血方法和过程,各医院间仍存在很大差异,仍需对该技术的流程进行规范并制定统一指南。Objective To investigate the current application of exchange blood transfusion(EBT)in neonatal intensive care units in China.Methods The questionnaire,designed on the Internet,was sent to the 38 members of the Children′s Blood Transfusion Branch of Chinese Medical Doctor Association via Wechant App from April to June in 2019,covering 31 provinces and cities in China.The questionnaire,consisted of 27 questions mainly focusing on the implementation of EBT,was then completed by the neonatal doctors/pediatricians or transfusion physicians from the hospitals involving neonatal exchange transfusion.Results A total of 259 valid responses were received,and 77%(199/259)of the respondents had less than 20 EBT cases in 2018.The EBT guidelines issued by the American Academy of Pediatrics(AAP)in 2004 were widely adopted by most hospitals.38%(98/259)of the respondents routinely used albumin before EBT,44%(114/259)routinely injected calcium intravenously during EBT,and 72%(186/259)suspended the blue light irradiation during EBT.58%(150/259)of the respondents adopted the ratio of red blood cells to plasma as(2—3)∶1,and 21%(54/259)of the them were unclear of the correct definition of"fresh"donor blood for EBT.Infections,circulation disorder due to unbalanced in and out procedure,biochemical and metabolic disorders were considered the major complications related to EBT.Conclusion An obvious divergence was seen in the treatment,protocol and process for EBT among the domestic hospitals,hence,it is necessary to standardize the EBT procedures and formulate unified guidelines.

关 键 词：新生儿换血术 新生儿高胆红素血症 问卷调查 

分 类 号：R722.18[医药卫生—儿科] R457.11[医药卫生—临床医学]